Box 1.
Private Mailbox (PMB) Information

List the date you’ll open your private or virtual mailbox, plus the date you plan to close it. If you plan to leave the mailbox open indefinitely, leave Box 1b blank. Write the date in month/day/year format.

Box 2.
Commercial Mail Receiving Agency (CMRA) Place of Business Information

Provide the street address of your private or virtual mailbox service location (include house number, street, and apartment/suite number if applicable) and your assigned mailbox number.

Box 3.
Type of Service Requested

Check the appropriate box if you’ll be using the service for a business, an organization (ex: a nonprofit or government agency), or residential/personal use.

– For Business/Organization Use, complete Box 7.
– For Residential/Personal Use, complete a separate PS Form 1583 for each adult using this PMB.

Box 4.
Name of Applicant

Fill out this section with your full name, phone number, email address, and home address.
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The address you write in Box 4f must match the one in Box 9b.

Box 5.
Authorized Individual

This section authorizes a designated individual from your service provider’s company to manage your mail. Provide their full name, phone number, email address, and home address.

The address added in Box 5f must match the one in Box 11b.

Box 6.
If Transferring PMB Mail to Another Address

Complete this section only if you need mail addressed to this PMB to be transferred, mailed, shipped, or emailed to a different address.

Box 7.
Business/Organization Information

Provide the following information:
1. Business Name
2. Type of Business
3. Full Street Address
4. Phone Number
5. Place of Registration (the county and state, if in the U.S. For businesses registered overseas, specify the country.)

Box 8.
Photo ID Information for Applicant

Fill out your name, ID number, issuing entity of your ID, and expiration date exactly as shown on your photo ID.

In Box 8e, specify the type of photo ID you’re submitting (check one of the acceptable types of photo IDs).*

Box 9.
Address ID Information for Applicant

In this section, provide a document verifying your home street address (international addresses accepted). Enter your name and home street address as written on the attached document.

In Box 9g, specify the type of document you’re submitting (check one of the acceptable types of photo IDs).*

Box 10.
Photo ID Information for Authorized Individual (if Applicable)

The authorized individual for your mailbox service will need to complete this section and is required to include their name, ID number, issuing entity, and expiration date.

In Box 10e, specify the type of photo ID you’re submitting (check one of the acceptable types of photo IDs).*

Box 11.
Address ID Information for Authorized Individual (if applicable)

This section serves as address verification for the authorized individual responsible for your mailbox service.

In Box 11g, specify the type of photo ID you’re submitting (check one of the acceptable types of photo IDs).*

Box 12.
Exceptions for Additional Recipients of Mail

Here you can include additional people from your business or organization who are authorized to receive mail at your virtual or private mailbox.

1. Business/Organization Use: List members who will be receiving mail at this PMB. Each person listed must, upon request, present two forms of valid ID to the Postal Service.

2. Residential/Individual Use: A parent or guardian may receive the mail of a minor by listing the minor’s name — the minor’s ID is not required.

Box 13.
Signature of Applicant and Date

Sign your name and add the date.

Box 14.
Signature of Witness and Date

A witness with sign and date the form here. The witness can be the agent, an authorized employee, or a Notary Public.
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Note: At the bottom of the form, there is a box for the notary public to fill out. If your mailbox provider requires notarization, you can take this form to a notary or use an online notarization service to fully complete this section.